Research Square · Oct 22, 2026
METS-IR combined with four body shape indices and progression to diabetes or reversion to normoglycemia in middle-aged and older adults with prediabetes: a longitudinal analysis of the China Health and Retirement Longitudinal Study
By Liu Y, Xin W
Background Combining metabolic and anthropometric information may help characterize the heterogeneous course of prediabetes. We examined four products of metabolic score for insulin resistance (METS-IR) and body shape indices in a three-state framework that included progression to diabetes and reversion to normoglycemia. Methods This longitudinal analysis used the 2011–2012 and 2015 examinations of the China Health and Retirement Longitudinal Study. The cohort was independently reconstructed from wave-specific source records and included adults aged ≥ 45 years with baseline prediabetes and recorded fasting blood draws at both examinations. Baseline METS-IR was multiplied by body roundness index, Chinese visceral adiposity index, weight-adjusted waist index, or a body shape index. Multinomial logistic regression estimated odds ratios with community-clustered 95% confidence intervals, using maintained prediabetes as the reference. Restricted cubic splines and model-standardized probabilities characterized nonlinear associations and the distribution of all three glycemic states. Results Among 2,134 participants, 329 progressed to diabetes, 467 reverted to normoglycemia, and 1,338 maintained prediabetes. The fully adjusted analysis included 2,116 participants from 343 communities. All four baseline products were associated with higher progression odds, with odds ratios per standard deviation ranging from 1.46 to 1.53 and all 95% confidence intervals excluding one. The product with a body shape index was also associated with lower reversion odds (odds ratio 0.87, 95% confidence interval 0.76–0.99). Across products, spline-standardized progression probabilities increased and reversion probabilities decreased between the lowest- and highest-quartile representative values. Probability differences ranged from 14.8 to 17.1 percentage points for progression and − 9.2 to − 7.7 percentage points for reversion; all contrast confidence intervals excluded zero. Progression associations remained positive under an alternative endpoint definition omitting glycated hemoglobin. Conclusions Baseline METS-IR–body shape products characterized glycemic progression and reversion among Chinese adults with prediabetes. Relative odds and standardized three-state probabilities describe different aspects of glycemic heterogeneity and inform further research on combined metabolic and anthropometric assessment.